Discuss about the case study for Quality of Health and Social Care.
1.1 Quality of health care in a case where one or more patients are infected with Staphylococcus aureus infections that are methicillin resistant is a cause of concern for all the stakeholders involved in patient care and those receiving care and their families. The fact that MRSA can cause increased morbidity and mortality in patients who may be suffering from health conditions related to old age makes it important that the quality of care be of a high standard. Health and social care workers, voluntary organisations, policy makers, hospital administration and service staff each have a perspective and a definite role on how to control and minimize infections acquired at the health care facility.
According to the American Academy of Nursing Expert Panel on Quality Health
“achievement of appropriate self-care, demonstration of health-promoting behaviours, health-related quality of life, perception of being well cared for, and symptom management”
are the defining parameters of high-quality care (Mitchell, 2008). Quality in healthcare can be assured by evaluating and assessing the quality of care provided to the patient. The deficiencies while delivering care have to be identified. Remedial measures to remove deficiencies and constant monitoring to detect lapses in following the improved procedures of patient care need to be implemented. Patient- centric approach while maintaining quality in health and social care is important, since the earlier model of treating symptoms without much attention to patient’s opinion could not ensure quality.
The basic premise of quality function deployment in healthcare requires an understanding of what the patient wants and needs. Improved communication with the patient leads to a more transparent method. Every opportunity for improving the delivery of healthcare has to be identified and changes made to the process. A better understanding of the patient as a person and giving high priority to the patient’s needs can ensure improvement in quality (Gremyr & Raharjo, 2013).
Delivering high quality healthcare depends on the level of coordination between the patient and the service provider. An atmosphere conducive to maintain quality is important. External factors in maintenance of quality include availability of resources while a collaborative understanding among the service providers improves the quality of patient care.
Measurement of the quality of service is important in the assessment of the quality of healthcare delivered. A multi-item SERVQUAL questionnaire in a study of patient responses to quality of healthcare delivered at an NHS facility was assessed. Patients require empathy from the staff, a relationship that harbours mutual respect, their dignity should be respected, an understanding of the illness and religious requirements and the availability a physical environment that is comfortable. In a scenario where availability of funds is scarce, it is difficult to improve quality in areas where financial inputs are required. Identification of shortcomings in the delivery of care can be identified by employing this method of quality evaluation.
Conclusion
Spread of an MRSA infection in a healthcare facility indicates poor quality control. Health-related quality of life of patients largely depends on the cooperation and coordination among the service providers. Deficiencies in the provision of care and short-comings in the process of patient care can subject the service user to harm. Healthcare quality in patient care has to given high priority. Methods have to be employed for measurement of quality of healthcare delivered.
1.2 External agencies are important as they set guidelines and standards to be adhered to by the care homes and hospitals. The provision of training programs for the nursing staff helps the service providers in adhering to high quality delivery of services.
National Institute for Health and Care Excellence (NICE)
The standards lay out the guidelines for practice and contain statements to fulfil the purpose. Measurement of progress is facilitated through instructions about how to measure whether the requirements stated in the statement were met. At NICE the emphasis is on producing advice and guidelines for practitioners in the field of social care, health and public health. The guidelines are evidence based. The development of quality standards and tools for measuring adherence to quality parameters for health care professionals is an important function. Provision of information for the people in the healthcare industry is another important role fulfilled by NICE (Anon., 2016).
Care Quality Commission (CQC)
The role of the Care Quality Commission is to set guidelines for healthcare professionals and enforce adherence to the rules by the service providers. A team of experts carries out inspections to assess the quality of care provided by hospitals, care facilities and clinics (Anon., 2015).
Social Care Institute for Excellence (SCIE)
The institute provides accredited training to staff involved in adult social care and consultancy support during CQC inspections. The institute develops and upgrades instructional material for service staff. Development of a skilled workforce is an area of priority for the institute.
1.3 The impact of poor service quality by different stakeholders of the health and social care system can cause harm to the patient. The patient may suffer from mental or physical impairment including the spread of infections. An error in communication between practitioners or between a practitioner and non-medical staff may cause harm to the patient. Errors in delegation of tasks, improper referral, incorrect use of resources can compromise the health care provision to the patient. Negative outcomes may result for the patient if there are lapses in patient management and shortcomings in making clinical decisions about the patient’s health (Mitchell, 2008).
References
Anon., 2015. /regulations-service-providers-and-managers. [Online]
Available at: https://www.cqc.org.uk/content/regulations-service-providers-and-managers
Anon., 2016. standards-and-indicators. [Online]
Available at: https://www.nice.org.uk/standards-and-indicators
Gremyr, I. & Raharjo, H., 2013. Quality function deployment in healthcare: a literature review and case study.. International Journal for Healthcare Quality Assurance, 26(2), pp. 135-46..
Hunter, C. et al., 2015. Perspectives from health, social care and policy stakeholders on the value of a single self-report outcome measure across long-term conditions: a qualitative study. BMJ Open, 5(5), p. e006986.
Mitchell, P., 2008. Defining Patient Safety and Quality Care. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses.. Rockville: Agency for Healthcare Research and Quality.
Tomes, A. & Peng Ng, S., 1995. Service quality in hospital care: the development of an inâ€Âpatient questionnaire. International Journal of Health Care Quality Assurance, 8(3), pp. 25 – 33.
Task 2
2.1 As compared to the emphasis on quality management in hospitals and clinics, the focus on quality in health and social care leaves room for improvement. Lord Darzi’s definition of quality care includes the three premises of being safe, being effective and care which is satisfying for the patient. Each of these premises is an important for maintaining and giving high quality care and one is more important than the other (Foot, et al., 2014 ; Anon., 2011). It is also important the care be cost effective because the recurring issue of insufficient funds means that care has to be imparted but within the financial restrains that care facilities often encounter.
One parameter that distinguishes the patients in care facilities is that the long term care is focussed at restoring health and bringing about improvements in the health and well-being of patients. An unfriendly cardiac surgeon may be able to restore health in a hospital for a patient who is being treated during a short-term hospital stay. But unfriendly staff in a residential care facility will immediately be classified as poor quality care because grumpy behaviour will reduce patient satisfaction.
Benchmarking provides an important input into how to compare care giving at one institution with those that have better practices, acknowledge the fact and try to match standards of quality of care with other institutions. It allows care facilities to identify their strengths and weaknesses. Benchmarking helps in the identification of gaps in performance and provides a means to bring about changes, improve quality and work towards higher customer satisfaction (Anon., 2014).
2.2 The definition of quality in healthcare delivery emphasizes the importance of safety, efficiency and ensuring positive outcomes for patients to the maximum possible extent. Quality in care can be ensured only when the standards are maintained throughout the system. Consistency in maintaining high standards of quality can help attain the goal of providing satisfactory service to the patients and their families.
In the case study, the spread of MRSA infections could have occured due to weak immune system of patient, deficiencies in performance by service givers, such as improper hand hygiene, transfer of infection from one patient to another or transfer of infection from a staff to the patient. In all of these scenrios the quality of care was below par and a preventable illness due to the infection could not be controlled.
It is important to measure the quality of care provided and in the case study, the qulity has been found to be below par because the elderly patients have been harmed due to the system failure that led to the spread of antibiotic methicillin resistant infections. One method could be the employment of continuous measurement and comparison of key results of improved processes with results at facilities with no cases of infection acquired at the facility. Another method could be to employ the Taotl Quality Management where the staff is trained to strive for constnt improvement in quality of services delivered.
2.3 The degree of adherence to quality standards and recommended guidelines is lower than expected. Several barriers on the road to implementation of the guidelines need to be identified and removed. The constraint of time expressed by some care-giving staff can be solved through provision of support and training leading to improvement in commitment towards their duty. Lack of leadership is another barrier to delivering high quality healthcare. The difference in perceptions between the executive staff and service staff also plays a role. Clinical outcomes and patient satisfaction were high on the list of the priorities of nursing staff whereas the managers rated operational effectiveness as more important.
Lack of consistent training in aspects of quality among the managerial and nursing staff is yet another barrier to delivery of quality services. A survey found that a quarter of the staff had not received training in quality improvement programs, a quarter was trained in all aspects, another quarter had received training but with considerable gaps. The last quarter were trained in governance and audit related to quality assessment.
Staff appraisals at regular intervals can help reward those who strive to maintain quality. But most staff has experienced that adherence to quality is rarely measured as part of an appraisal. If quality is made a parameter for measuring and rewarding performance during an appraisal, adherence to systems that ensure quality in delivery of service will be followed by staff. (Chrystie, 2012).
Quality standards for end-of-life hospices address concerns of the stakeholders, the hospice, the patient, the family and the staff. Compassionate care and empathy are the main tenets of these standards. In these cases the death of the patient is inevitable but the hospice and the staff make the best possible outcome for the patient and the family a priority (Anon., n.d.).
The Regulation and Quality Improvement Authority monitors and inspects the quality of services provided at the health and social care facilities. Importance is placed in particular on whether the services being provided are safe, ensure well being of the service users in a protective environment. The Authority can enforce compliance with standards if a care home is found not complying with standards (Anon., n.d.). The foremost requirement for improvement in quality standards has been to sensitize staff about a constant need for quality improvement. Training staff in development of quality improvement methods can be an effective strategy. The steps for improving quality can be taken in the following order:
In conclusion, constant effort to improve quality of service t health care facilities is necessary. Various tools are available that facilitate systemic surveillance about adherence to procedures and train and upgrade staff towards commitment to quality.
Ms. X came to visit her father at the residential care facility where she had transferred him because she was unable to meet his complex needs of health care on her own at home. Her father is 75 years old, with diabetes, hypertension and intermittent dementia and of Asian descent and could not speak English well. On seeing him she found him to be rather depressed. When she asked he said he did not want to stay there. On further enquiry, she found that the care staff ignored his request because they could not understand him. However, the prescribed medications were being administered to him regularly.
Role of care provider:
The care provider/s appeared ignorant of the fact that it was their duty to make Ms. X’s father comfortable despite the language barrier. It was part of their responsibility to make him feel comfortable. But instead they ignored his requests for small needs because they said they could not understand him. The care facility did not have a system in place where they could seek help from a volunteer service for a translator occasionally.
Role of service worker:
The service worker continued to administer medicines and took steps that would prevent falls because Ms X’s father was rather frail. Her training fell short and she did not take up the matter with her superiors. The result was an unsatisfied patient and his family. The daughter lodged a formal complaint in this regard and complained that her father had faced discrimination at the care facility.
3.1 Several rules and policies have been formed for delivery of health and social care that does not discriminate patients on the grounds of language, ethnicity, cultural, and religious background. Discrimination on the basis of language causes lower levels of satisfaction because the patients feel that they are not being understood. Bilingual service providers can communicate with the patient more effectively because they speak the same language. This immediately makes the patient feel less discriminated and the levels of satisfaction are much better. But standards should now define the path to be taken when bilingual service providers are not available.
Due to increasing globalisation, high mobility and migrants from other countries settling in the United Kingdom, the barrier of language is being felt increasingly, in a society that is becoming multilingual and multi-ethnic. Care homes may find individuals of different ethnicities opting for their services. In such a scenario, it is helpful to employ staff from different ethnicities and staff who are trained and sensitized in dealing with patients from different cultures, religions and ethnicities.
3.2 It is important for the service giver to understand that a diverse background of patients can give rise to discrimination. It is important to remain aware of equality and include so that discrimination can be minimized. Every incident of discrimination causes misery to the patient. It also results in delivery of low quality care. The service giver has to ensure during the course of discharge of duties that the values and preferences of patients and colleagues are respected at all times. And the service users are assured of an environment that is conducive to the maintenance of their culture and beliefs. The confidence that stems from such an atmosphere at a care home is likely to have satisfied service users and their families remain assured of a best possible outcome.
3.3 It is important that complaints from patients and their families should be encouraged whenever a deficiency in service is encountered by them. Each complaint is an opportunity to improve service. Rather than being defensive in the event of a complaint, the system should encourage and give the complainant a patient hearing. An atmosphere of openness should be harboured that treats each complaint as a stepping board for bringing changes in the service that improve the delivery of service. Not only patients, but concerns raised by colleagues should be received openly. This will lead to a system that is responsive and ready to remove the basic malady that may be causing a lower quality delivery of service.
A system that is open to change is more likely to function like a well oiled machine. Patient’s families should be encouraged to share difficulties encountered and they should not fear a backlash and an impact on the care received by their dear one/s nor should they be worried about a reprisal if a complaint is made. Welcoming a complaint or concern can only bring about betterment of the system.
Health and social care is a complex and difficult area where a small lapse from the service giver can result in a major flaw in quality of care delivered. A culture of honesty and openness is correcting and reporting errors can enhance the quality of service delivery. Continuous improvement in quality of services delivered has to be systemically driven. Each individual responsible for service delivery has to contribute with constant inputs for improving quality. Preventing fatalities and improving the quality of life of patients with long term care requirements is the duty of service providers.
Regulations help in keeping service providers alert and conscious about delivering quality, but regulations should take into account the point of view of all stakeholders including the service providers. If they have to take the brunt of failure they might as well have a voice in how regulations are framed and practised. A system that is fair to all stakeholders has a better chance of success. Just as service providers are answerable when low quality delivery is noticed, providing them with rewards or incentives on delivering service of a high quality can go a long way in ensuring that quality requirements will be met.
Providing interventional educational programs for raising levels of quality care to service providers is an important step. Sharing new methods of service delivery and providing them with updates can reinforce their knowledge base and improve quality of service.
4.1 Evaluating methods for evaluation of service quality in health and social care is done from an internal perspective by using questionnaires to patients who assess the quality of care provided. But the framing of questionnaires as tools of measuring quality can vary to a large extent. Properly validated and reliable questionnaires offer a standardised tool for quality measurement, but when formed by private vendors, the questionnaires may often have low reliability. Internal assessment questionnaires are a third kind of tool used to measure quality and may contain questions taken from validated questionnaires. The main objective of the tool is that of measuring quality. Once quality measurement is done in a reliable manner, there is scope for improvement in quality of health care delivered based on the findings of this important tool.
The basic objective of the questionnaire is to determine how patients rate the experience at the care facility and this can help in transforming the way patients are cared for in health and social care facilities. It is in the interest of hospitals and care institutions to make an investment in time and finances directed at collecting patients ‘evaluation of services so that the delivery of care and care services can undergo radical transformation (Urden, 2002).
The fishbone diagram shows the relationship between cause and effect and can be used as an effective tool to bring out the basic issues that gave rise to a problem, such as healthcare associated infections as in the case study. It gives a structured flow to the discussion by a group of people responsible for controlling the problem. It becomes easier to identify training needs, gaps and lacunae that led to the problem initially. (Anon., 2007).
The impact of involving service users in the evaluation process on service quality has been immense in improving the quality of service provided. WHO is in favour of involving service user feedback for quality improvement. The accessibility and dissemination of information about services has improved. A greater coordination in care -giving and between the doctors and patients has emerged. (Omeni, et al., 2014). Positive clinical outcomes for patients and better self esteem have also resulted and this a favourable impact of the service users involvement in the evaluation of service quality that they receive. There have been reports where the service providers may have discouraged evaluation by service users and their involvement in affecting quality.
References
Anon., 2007. 9Final-Fishbone.pdf. [Online]
Available at: https://siteresources.worldbank.org/WBI/Resources/213798-1194538727144/9Final-Fishbone.pdf
[Accessed 28 July 2016].
Omeni, E. et al., 2014. Service user involvement: impact and participation: a survey of service user and staff perspectives. BMC Health Services Research, Volume 14, p. 491..
Urden, L., 2002. Patient satisfaction measurement: current issues and implications.. Lippincotts Case Management, 7(5), pp. 194-200.
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